Pharmacist

Upper Peninsula Health Plan•Marquette, MI

9d•$52

About The Position

Responsible for assigned pharmacy functions in accordance with Upper Peninsula Health Plan (UPHP) plans and policies and all state and federal accrediting and regulatory standards; supports the pharmacy director in development, organization, implementation, and communication of pharmacy initiatives and projects to maintain and improve quality and cost effectiveness of administrative, operational, clinical, and drug utilization management programs.

Requirements

Pharmacy degree
Michigan licensure to practice without restriction
Two (2) years of pharmacy practice experience required
Keyboarding proficiency
Working knowledge of MS Office (Word, Excel, & Outlook)
Excellent human relation and oral/written communication, including public speaking
Excellent organizational, prioritization, and problem-solving abilities
Excellent attention to detail
Excellent self-management abilities
Composition and proofreading abilities
Electronic transfer of files/documents
Experience in interpreting data from multiple sources

Nice To Haves

Managed care or PBM experience
Clinical experience with focused patient and physician initiatives
Advanced experience with Microsoft Excel functionality (e.g., Pivot table, VLOOKUP, mail-merge, etc.)
Knowledge of MS PowerPoint

Responsibilities

Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
Demonstrates knowledge of all relevant Michigan Department of Health and Human Services (MDHHS), Centers for Medicare and Medicaid Services (CMS), and Department of Insurance and Financial Services (DIFS) standards; all applicable National Committee for Quality Assurance (NCQA) Utilization Management (UM), Quality Improvement (QI), and Member's Rights and Responsibility (RR) standards; and Healthcare Effectiveness Data and Information Set (HEDIS®) measures as they relate to pharmacy functions and respective programs; assumes responsibility for specific NCQA standards as assigned.
Identifies and contributes to the development and implementation of pharmacy programs to improve the cost- effective, evidence-based management of the prescription drug benefit and drug utilization program standards.
Performs clinical quality improvement activities and studies related to drug utilization and prepares reports and analyzes data as assigned.
Communicates with other health care professionals, internally and externally, including customer service, care managers, physicians, physician office staff, pharmacies, and pharmacy benefit manager (PBM) personnel in an effective and timely manner.
Responsible for the day-to-day processing of prior authorizations, appeals, override requests, grievances, member, and provider education calls in compliance with regulatory and clinical practice standards including timely and accurate record keeping and reporting.
Performs research, development, implementation, and maintenance of drug utilization management criteria, necessary to support clinical practice guidelines, formulary requirements, and drug utilization management activities.
Develops, prepares, and coordinates distribution of the drug formulary, newsletters and drug utilization management, and other materials for providers and members concerning formulary and pharmacy topics.
Assists in the development, maintenance, and execution of policies and procedures related to pharmacy management and performs duties in accordance with regulatory requirements and accrediting standards.
Performs duties as related to maintaining and preparing NCQA Standards, CMS audits, and other regulatory and contractual reporting as appropriate.
Responsible for conducting all responsibilities in alignment with CMS and MDHHS reporting and auditing requirements.
Performs monitoring, auditing, and follow up of fraud waste and abuse of medications and services.
Reviews member medication profiles and claims data and applies evidence-based medicine and national guidelines when crafting recommendations for health care providers.
Performs drug utilization review (DUR) activities by evaluating medication lists and claims history for potential drug interactions, suboptimal medication regimens, drug safety, and adherence concerns.
Performs outreach to members and providers as part of quality, drug utilization, and/or control initiatives.
Assists the Director of Pharmacy with educational opportunities for internal staff, members, healthcare providers, and pharmacy students/interns/residents.
Identifies and implements initiatives to enhance clinical outcomes and improved medication selection, utilization, and adherence.
Serves as a resource for other UPHP departmental personnel related to pharmacy program procedures, processes, and initiatives.
Assures required licensure continuing education requirements are fulfilled as required for maintaining a Michigan registered pharmacist license.
Attends and participates in organizational and departmental meetings as required.
Maintains confidentiality of client data.
Performs other related duties as assigned or requested.